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Biomedical subjects

M Manfrini

Publications and source records attributed to M Manfrini.

At least 55 records · Page 3Linked to original sources
PubMed1988

Orthotopic knee grafts in rats: a model for growth plate transplantation.

A model for orthotopic whole knee transplantation in syngeneic Lewis rats is presented. The donor knee was isolated on the femoral vessels 1 cm superior and inferior to the knee joint. A minimal muscle cuff was left attached to ensure adequate circulation to the graft via the popliteal vessels. The graft was transplanted to the recipient animal and secured in an orthotopic position by two intramedullary Kirschner wires. The graft pedicle was anastomosed to the recipient's femoral vessels and the muscular elements sutured. Preliminary results are reported, and future implications on growth plate autograft transplantation are discussed.

Anastomosis, Surgical↗
PubMed1988

Staging of intraosseous extent of osteosarcoma: correlation of preoperative CT and MR imaging with pathologic macroslides.

The accuracy of preoperative computed tomography (CT) and magnetic resonance (MR) imaging in the measurement of intraosseous tumor extent in 17 cases of osteosarcoma of an extremity was compared with macroslides of surgical specimens. Longitudinal intraosseous extension of tumor from the adjacent articular surface was measured on imaging studies and macroslides to the nearest millimeter. The average difference between macroslide and CT measurements (15 cases) was 16.5 mm +/- 10.7, and the average difference between macroslide and MR imaging measurements (17 cases) was 4.9 mm +/- 4.3. However, much of the latter difference appears to be caused by use of a different plane of section in MR imaging compared with that in macroslides, since in a subgroup of five specimens with an identical plane of section, the average difference was 1.8 mm +/- 1.6. The authors conclude that MR imaging is extremely accurate in the assessment of intraosseous extent of osteosarcoma.

Adolescent↗
PubMed1988

A critical review of the surgical treatment of infantile fibrous dysplasia.

A critical review of the surgical treatment of 65 cases of infantile fibrous dysplasia demonstrated that "circumscribed" forms of the disease generally do not require any type of surgical treatment, while "extended" forms, as well as Albright's syndrome, require early surgical treatment aimed at preventing the development of skeletal deformities which are difficult to correct. Prophylactic intramedullary nailing with nails of suitable calibre most effectively achieves this goal.

Adolescent↗
PubMed1988

[Angiographic evaluation of the response of osteosarcoma to neoadjuvant chemotherapy].

Modern therapeutic osteosarcoma protocols, including both pre- and post-operative cycles of chemotherapy, have helped improving the quality of the prognosis and marking the local control of the neoplasm more reliable, with a subsequent increase in conservative surgery. Angiographic results of the chemotherapeutic response in 76 patients with primitive high-grade bone osteosarcoma are reported. The need to repeat angiographic controls under the same technical conditions is emphasized. The comparison of the above findings with data from the histological evaluation of the specimen, shows that angiography is a reliable means of evaluating the response to chemotherapy. Angiography is thus emphasized as a valid method in an early evaluation of the efficacy of chemotherapy.

Adolescent↗
PubMed1988

Arthromyolysis of the elbow in arthrogryposis.

The authors discuss the indications and describe the technique of arthromyolysis of the elbow in arthrogryposis and report 17 operations performed on 10 patients followed up after an average of 4.5 years. Their results show that this type of operation considerably improves passive mobility of the elbow and is capable of conferring adequate function on the limb, even without recourse to subsequent muscle transposition into the paralysed biceps.

Activities of Daily Living↗
PubMed1987

Prognostic value of serum alkaline phosphatase in osteosarcoma.

In 163 patients with osteosarcoma of the extremities treated with adjuvant chemotherapy, serum alkaline phosphatase (SAP) levels were evaluated before treatment and successively closely monitored in an attempt to determine whether serum levels of this enzyme had clinical value in predicting the course of the disease. Of 121 patients with elevated preoperative SAP levels, 78 (64%) recurred. Of 42 patients with normal preoperative SAP levels, only 8 (19%) recurred (P less than 0.00001). Of the 140 patients locally treated with amputation, SAP returned to normal values in 77 patients; 46 of these (59%) relapsed. Of the 21 patients whose SAP remained elevated after amputation, all but 2 relapsed (90%). Among 119 patients with normal postoperative values of SAP, at the time of relapse SAP resulted elevated in 22 of 41 patients (53%). These data confirm that in osteosarcoma, preoperative SAP levels have a definite value in establishing the prognosis and that posttreatment follow-up examination should include SAP determination, since persistent elevated or increasing values herald the appearance of a recurrence.

Adolescent↗
PubMed1987

Synthesis and antifungal activity of 4-thiazol-2-yl-5-aminopyrazoles and 4-aminopyrazolo [3,4-c] isothiazoles.

Starting from 4-thiocarbamoyl-5-aminopyrazoles (I), the AA could prepare two series of products: 4-thiazol-2-yl-5-aminopyrazoles (II) and 4-aminopyrazolo [3,4-c] isothiazoles (III). The screening for in vitro antifungal activity evidenced that compounds (III) are effective in controlling most examined fungi; in particular 1-phenyl-3-methyl-4-aminopyrazolo [3,4-c] isothiazole (III a) at the concentration of 20 p.p.m. completely inhibited the growth of Pythium ultimum and Corticium solani, responsible for the collar rot of the beet.

Antifungal Agents↗
PubMed1986

Therapy for primary non-Hodgkin's lymphoma of bone and a comparison of results with Ewing's sarcoma. Ten years' experience at the Istituto Ortopedico Rizzoli.

The authors report on the results obtained in 30 consecutive cases of primary non-Hodgkin's lymphoma of bone (PNHLB) treated at the Istituto Ortopedico Rizzoli between 1972 and 1982. Four patients were treated with radiotherapy only and 26 were treated with radiotherapy plus adjuvant chemotherapy. At a median follow-up of 86 months (range, 30-160), among the 26 patients treated with chemotherapy also there were 3 relapses (2 had meningeal involvement and 1 had recurrence in another bone). Relapse (local recurrence plus multiple new localizations) was observed in one of the four patients treated with radiotherapy only. These results are compared with the results of 68 patients with Ewing's sarcoma who were treated during the same period with radiation therapy and adjuvant chemotherapy and reported in a previous study. In this group, the disease-free survival rate was only 32% (20/68) with a much higher incidence of local recurrence (31%). The necessity of making a clear distinction between PNHLB and Ewing's sarcoma is discussed.

Adolescent↗
PubMed1986

Neoadjuvant chemotherapy for high grade osteosarcoma of the extremities: is a good response to preoperative treatment an indication to reduce postoperative chemotherapy?

Sixty-five patients with high grade central localized osteosarcoma of the extremities were treated according to a neoadjuvant chemotherapy schedule that was comprised of two methotrexate (MTX) cycles (high or moderate dosage) i.v. followed by cisplatinum (CDP) (continuous i.a. infusion for 24 hours). Thirty-four "good" responders (necrosis greater than 90%) were divide in two groups for post-operative treatment. The first group was treated for a short period (4 weeks) with i.v. MTX-CDP; the second group was treated for a longer period (24 weeks) with i.v. MTX-CDP and also adriamycin. Patients in the second group had far better results than the patients in the first group (19/19 vs. 5/15 continuously disease-free patients). Our results following this protocol indicate that even if patients are "good" responders to this neoadjuvant chemotherapy they should not undergo a shortened post-operative treatment, and the protocol should include adriamycin.

Adolescent↗
PubMed1985

Meniscectomy in children. Evaluation of results after growth has ceased.

The results of 28 total meniscectomies in children were reviewed after the end of the growth period. From a purely clinical point of view these were satisfactory in 26 cases and in the remaining 2 cases the poor results were due to faulty initial diagnosis. From the radiographic survey, 50% of cases showed early signs of degenerative arthritis in the femorotibial joint, but there was no evidence of the patellar syndrome. In meniscal lesions in children, the surgical approach should therefore be as conservative as possible.

Adolescent↗
PubMed1983

Giant-cell tumor of bone in skeletally immature patients.

Giant-cell tumor of bone is predominantly an affliction of adults and is rarely found in skeletally immature patients. We are reporting six new cases of histologically confirmed giant-cell tumor of bone in patients with radiographically open epiphyseal plates. These patients account for 1.8 per cent of the 326 giant-cell tumor of bone observed at the Bone Tumor Center of the Istituto Ortopedico Rizzoli in Bologna, Italy.

Adolescent↗
PubMed1982

Frequency and prognostic value of HLA antigens in osteosarcoma patients.

A homogeneous group of 53 Caucasian subjects with high-grade osteosarcoma (OS) was typed for HLA-A and B locus antigens. Although no significant differences in the distribution of these antigens were found in comparison with 425 local controls, a trend towards an increase of HLA-B18 and decrease of HLA-B12 was observed. All the patients underwent amputation plus adjuvant chemotherapy and among the 29 patients with a follow-up longer than one year, 9 out of 10 subjects with HLA-A3 antigens developed metastases within a few months. None of the OS patients had the HLA-A3, B7 haplotype which is present in linkage-disequilibrium in the control population.

Adolescent↗
PubMedDate not supplied

Latissimus dorsi pedicled flap applications in shoulder and chest wall reconstructions after extracompartimental sarcoma resections.

AIMS AND BACKGROUND: In sarcomas of shoulder and of chest wall, latissimus dorsi muscle gives the opportunity to solve any plastic problem without recourse to free flaps. The authors report their experience in the use of latissimus dorsi pedicled flap as adjuvant procedure in the surgery of bone and soft tissue sarcoma. METHODS: The latissimus dorsi pedicled flap was used in seventeen patients to reconstruct composite tissue defects after sarcoma resection of the shoulder or of the chest wall. Three groups were recognized. The eight patients of Group I received the flap to close the chest cavity after a multiple rib resection performed to remove a tumor of the chest wall. In Group II four patients had the latissimus dorsi transported to reconstruct the soft tissue coverage over a proximal humerus prosthesis previously applied after bone tumor resection. The five patients of Group III had the flap performed at the same time of the resection of a tumor arising in the shoulder area (1 bone and 4 soft tissue sarcoma). RESULTS: Two patients of the Group II presented a recurrent skin failure. A satisfactory coverage without any flap complication was provided in all the other 15 patients (88%). CONCLUSIONS: Latissimus dorsi pedicled flap represents a reliable and effective technique to reconstruct large chest wall or shoulder soft tissue defects.

Adolescent↗
PubMedDate not supplied

Nonmetastatic osteosarcoma of the extremity: results of a neoadjuvant chemotherapy protocol (IOR/OS-3) with high-dose methotrexate, intraarterial or intravenous cisplatin, doxorubicin, and salvage chemotherapy based on histologic tumor response.

AIMS AND BACKGROUND: From 1986 to 1989, a study for the treatment of nonmetastatic osteosarcoma of the extremity (IOR/OS-2) was carried out at the Rizzoli Institute. The cumulative dose of doxorubicin delivered was 480 mg/m2, and severe heart failure developed in 5 (3%) of the 164 treated patients. The specific aim of the subsequent study was to assess the efficacy of a protocol, similar to IOR/OS-2, but with a reduced cumulative dose of doxorubicin (390 mg/m2). Additional aims were to assess the role of the route of infusion (intraarterial or intravenous) of cisplatin on histologic response of the primary tumor and the use of ifosfamide as salvage chemotherapy in poor responders. METHODS: The new chemotherapy regimen (IOR/OS-3) was comprised of a preoperative phase with methotrexate (10 g/m2), cisplatin (120 mg/m2 intraarterially or intravenously), and doxorubicin (60 mg/m2). After surgery, the same drugs were administered, with the addition of ifosfamide (10 g/m2) in patients who had a poor histologic response to primary chemotherapy. RESULTS: Ninety-five patients entered the study. The rate of good histologic response was 64% with intraarterial cisplatin and 43% with intravenous cisplatin (P = 0.05). The 8-year event-free survival and overall survival were 54% and 61%, respectively, with no significant difference according to the histologic response. No cases of clinical doxorubicin-induced cardiopathy were recorded. Event-free and overall survival did not significantly differ from those achieved with IOR/OS-2 (8-year disease-free and overall survival, respectively 63% and 72%). CONCLUSIONS: The reduction in the doxorubicin cumulative dose avoided episodes of cardiotoxicity, without consequences on the efficacy of treatment. The addition of ifosfamide was an effective "salvage" therapy for poor responders. A better histologic response with intraarterial cisplatin was observed, but owing to the availability of an effective salvage therapy for poor responders, the advantages in terms of histologic response did not compensate for the cost and discomfort for the patients of this modality of infusion of cisplatin.

Adolescent↗
PubMedDate not supplied

Neoadjuvant chemotherapy for osteosarcoma of the extremities with synchronous lung metastases: treatment with cisplatin, adriamycin and high dose of methotrexate and ifosfamide.

We report on the clinical course and outcome of 28 patients, treated at The Istituti Ortopedici Rizzoli between 1995 and 1997 for osteosarcoma of the extremities metastatic to the lung at presentation. The treatment for these patients was the following: primary chemotherapy with cisplatin, adriamycin and high dose of methotrexate and ifosfamide followed by simultaneous resection of primary and metastatic lesions (when feasible), and further chemotherapy. After primary chemotherapy, lung metastases disappeared in 6 patients, whereas metastases in 3 remained surgically unresectable. These 9 patients received surgical treatment of the primary tumor only. In the remaining 19 patients, after chemotherapy, a simultaneous resection of the primary and metastatic tumor was performed. The resection of metastatic lesions was complete in 18 cases and incomplete in one. Three of the 4 patients who did not achieve a tumor-free status died in a few months and one is still alive with uncontrolled disease. With a median follow-up of 32 months (19-43) of the 24 patients who achieved remission, 12 (55%) remained continuously free of disease, 11 relapsed with new metastases and 1 died of chemotherapy-related toxicity. The 2-year DFS and OS were 36% and 53% respectively. These results are much worse than those achieved in 114 contemporary patients with localised disease (2-year DFS: 81%) treated in the same period and they are superimposible to the results achieved in 23 patients previously treated with the same protocol, but with standard dose of ifosfamide (2-year DFS: 32%). However, it must be underlined that, as regards prognosis, patients with metastatic disease at presentation are a hetero-geneous group. The DFS was significantly higher for patients with only one or two metastatic lesions than for patients with 3 or more lesions (2 year DFS: 78% vs. 28%). In 12 of the 19 patients who had a complete simultaneous resection of the primary and metastatic tumor, a strong correlation between the degree of necrosis of the primary and metastatic lesions was found. We conclude that in patients with osteosarcoma of the extremity with lung metastases at presentation: a) the combination of aggressive chemotherapy with simultaneous resection of primary and metastatic tumors works very well only for those patients who present with one or two metastatic nodules whereas for patients with 3 or more pulmonary metastases the prognosis is very poor; b) within the 4-drug regimen used in this study, the increment of ifosfamide dose from 10 g/m2 to 15 g/m2 for cycle does not improve prognosis; c) the strong correlation found between the histologic response of the primary tumor and metastases supports the strategy, largely used nowadays in the neoadjuvant treatment of osteosarcoma, of tailoring postoperative chemo-therapy on the basis of the primary tumor histologic response to preoperative chemotherapy.

Adolescent↗
PubMedDate not supplied

The role of vascularized fibula in skeletal reconstruction.

Since March 1988, 144 oncologic bone resections have been surgically treated with vascularized fibula (VF). In 30 patients VF was used after the failure of previous reconstructions, while in 114 cases (79%) VF immediately followed tumor resection. In 14 cases VF was pedicled on its vessel and used to reconstruct the ipsilateral tibia. In 17 young children, the proximal fibula was used to reconstruct with a potential growth the proximal humerus, the distal radius or the proximal femur. In 103 cases VF was combined with bone allografts. In 70 of these the fibula was inserted inside the massive allograft as a viable rod. There were 7 mechanical failures, 9 deep infections, and 10 local recurrences. According to functional evaluation, 69 patients (48%) presented with excellent functional results, 39 patients (27%) had good results while fair of poor results were recorded in 36 cases (25%).

Adolescent↗